Re-innervation after heart transplantation: a multidisciplinary study

• Published in: The Journal of heart and lung transplantation Vol. 23; no. 6; pp. 674 - 682
• Main Authors: Gallego-Page, Juan Carlos, Segovia, Javier, Alonso-Pulpón, Luis, Alonso-Rodríguez, Mercedes, Salas, Clara, Ortíz-Berrocal, José
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2004; Elsevier Science
• Subjects: 3-Iodobenzylguanidine; Adolescent; Adult; Aged; Biological and medical sciences; Case-Control Studies; Cross-Sectional Studies; Female; Heart - diagnostic imaging; Heart - innervation; Heart - physiopathology; Heart Rate - physiology; Heart Transplantation; Humans; Male; Medical sciences; Middle Aged; Nerve Fibers - pathology; Nerve Regeneration; Radionuclide Imaging; Radiopharmaceuticals; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Transplants; Heart; Treatment; Respiratory disease; Surgery; Innervation; Graft; Cardiovascular disease; Transplantation; Homotransplantation; Multidisciplinary
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2003.07.011

Several authors have demonstrated the existence and implications of re-innervation in the transplanted heart. Our aim was to study this phenomenon using 3 different techniques and to analyze the correlation among them. The study population consisted of 55 patients who had undergone heart transplantation 0.5 to 160 months earlier. We used a control group of 10 healthy individuals for comparison. To detect re-innervation, we used 1) planar and single photon emission computed tomography (SPECT) scintigraphic imaging of cardiac sympathetic activity with 123I-metaiodobenzylguanidine (MIBG), 2) analysis of heart-rate variability based on 24-hour Holter recordings; and 3) immunohistochemical study of endomyocardial biopsy specimens with anti-S100 antibody. The SPECT images showed evidence of sympathetic re-innervation in 17 patients (31%), predominantly in the anterior and in the septal regions of the left ventricle. Sympathetic activity increased during the post-transplant time course (r = 0.32; p = 0.017), although it did not reach normal values. We found a correlation between the low-frequency component of heart-rate variability (a marker of sympathetic activity) and the degree of MIBG uptake according to scintigraphy (r = 0.32; p = 0.015). Immunostaining study demonstrated the existence of nerve fibers in 36 patients (65%) who had greater values of heart-rate variability parameters reflecting parasympathetic activity. The 3 techniques evidenced re-innervation after heart transplantation. A correlation exists between sympathetic activity detected using MIBG scintigraphy and analysis of heart-rate variability. Patients in whom endomyocardial biopsy specimen reveals the presence of nerve fibers show more parasympathetic activity in the heart-rate variability analysis.